HIE Use Cuts Costs, Increases Productivity in STI Treatment

New evidence suggests HIE use can contribute to cost savings and increased productivity in STI treatment and management led by public health staff.

October 26, 2017 - Health information exchange (HIE) use can lead to cost savings and increased productivity in sexually transmitted infection (STI) treatment and management, according to a new study published in Health Information Management Journal.

Haque et al. conducted the study with Erie County Department of Health (ECDOH) and HEALTHeLINK, as well as RTI International. Researchers aimed to measure the benefits of using health data exchange to obtain demographic, lab, and treatment information about STIs — specifically, chlamydia and gonorrhea — in the state’s most western county.

Results of the 2012 study showed time savings stemming from HIE use led to improved productivity at the county’s health agency. ECDOH expanded its disease investigation without increasing work hours or spending and expanded disease control and partner services to residents who may have been missed prior to implementing HIE use as part of the disease management process.

“The ability to ensure adequate STI treatment and efficiently locate and notify exposed partners to get them into care will cut the chain of transmission and reduce the disease burden for the entire community,” stated Commissioner of Health Gale Burstein, MD, in an email statement.

HIE use contributed to greater efficiency and time savings for disease intervention specialists to identify treatment requests, cases, and contacts.

In the study, staff received notifications of positive communicable disease lab results through the New York State Electronic Clinical Laboratory Reporting Surveillance (ECLRS) system. Following confirmation of a positive STI test result, staff utilized the HIE connection to obtain clinical, demographic, lab, and treatment data to determine if appropriate STI treatment had been administered. Additionally, staff used the HIE connection to monitor demographic and contact information on STI cases and their partners.

Researchers conducted in-person and telephone interviews about workflow changes with staff members from ECDOH, the New York State Department of Health, and HEALTHeLINK. Interviewees included public health commissioners, nurses, epidemiologists, investigators, and IT specialists. Researchers also collected and evaluated time motion data, epidemiologic reports, and workflows, along with wage and labor data to measure potential savings based on resources and improved disease surveillance.

For comparison, ECDOH provided data about quarterly success rates of STI patients and their partners before and after HIE implementation. Researchers found a significant increase in reported treatment rates for both chlamydia and gonorrhea.

“Reported chlamydia treatment rates increased from 77.5 percent in 2011 to 92.6 percent in 2013,” wrote researchers in the published report. “Reported gonorrhea treatment rates increased from 79.2 percent in 2011 to 94.7 percent in 2013.”

Despite this increase in reported treatments, epidemiologists still managed to save time and money by relying on HIE use to obtain patient demographic data instead of attempting to retrieve the information through providers or labs.

Epidemiologist staff members saved a total of 131 hours per year for chlamydia treatment monitoring and 46 hours per year for gonorrhea treatment monitoring.

“ECDOH epidemiologists estimate that obtaining demographic information in HEALTHeLINK rather than contacting the laboratory or ordering physician saved approximately 10 minutes of their time per case,” researchers stated. “Based on the number of demographic informational requests for chlamydia cases in 2012, we estimated that using HEALTHeLINK to obtain cases’ demographic information saved 63 epidemiologist hours, leading to an estimated $3,468 of salary savings.”

Previous research has linked increased cost savings for users to effective HIE use. A study released in September by University of Notre Dame researchers found that health information organizations and networks could potentially reduce healthcare spending by more than $3 billion a year.

Beyond generating opportunities for cost savings, Haque and others indicated HIE use could also be helpful in allowing for more efficient, comprehensive care management, patient tracking, and patient monitoring in public health.

“While we have demonstrated that an HIE, such as HEALTHeLINK, can be an excellent tool for gonorrhea and chlamydia surveillance and disease investigation, this is far from the only possible use of these systems,” researchers noted. “Other possibilities include HIV partner management, hepatitis surveillance, rabies investigations, tracking food-related outbreaks and syndromic surveillance for genetic diseases.”

HIE use could also reduce administrative burden on providers by allowing public health staff to look up patient EHRs on their own without requiring assistance from clinicians or hospitals. Furthermore, HIE use could enable chart reviews to be conducted remotely instead of on location at hospitals.

“With utilizing health information exchange for instant access to health information, providers can deliver more timely and effective care,” said HEALTHeLINK Executive Director Daniel Porreca. “These savings are having a significant impact on our population’s health, with resources able to be redirected for expanded awareness and proactive treatment.”